1. Guatemalan Maya
Lake Worth, Florida

2. Introduction
 The Guatemalan-Maya Center
 Founded in 1992, as a non-profit agency
 By Reverent Frank O'Loughlin
 Serves 18,000 persons yearly
 North F Street, Lake Worth, FL
 21 staff members
 Funded by the Children Service's Council, The Literacy
Coalition, and Family Central of Palm Beach County
(Fooksman, n.d.; Guatemalan-Mayan Center, n.d.)

3. Introduction
 The Guatemalan-Maya Center
 Family and baby outreach program
 Parent and child home program
 Escuelita afterschool program
 VPK summer program
 Translation services
 Legal help
 ACCESS FLORIDA services
(The Guatemalan-Mayan Center, n.d.).

4. Field Interview
(The Guatemalan-Mayan Center, n.d.).

5. Field Interview
 M. Martinez arrived in Florida during early 1980s
escaping violence brought upon by the Civil War
 The interview took a form of story telling
 M. Martinez told a story with each issue, problem, or
concern that she discussed
 The major problems and challenges of the
Guatemalan Maya people in Lake Worth are: lack of
language, working too many hours, lack of legal
documents, domestic violence, and no healthcare
coverage

6. Lack of Language
 24 different Mayan languages in Guatemala
 10 different Mayan languages in Lake Worth
 Spanish is also spoken by some
 Problems, especially, in healthcare to understand treatment
or their diagnosis
 There are differences in words and their meanings even in
Spanish
 Two stories: Cuban nurse at St. Mary’s and 18 year old boy
(M. Martinez, personal communication, May 30, 2013)

7. Working Too Many Hours
 Both parents often work
 Children are home alone or are taken care by others and
picked up late by the parents (Story of little girl)
 “There is no time to raise your children like you want to, but
this gives me strength to be here and help my people”
 Real problem is with teenagers: Are alone at home. They
are bored and running the streets, doing drugs, drinking
alcohol, selling drugs, prostitution, and gangs. Also girls
are leaving with older men and their mothers are worried
not knowing where they are
(M. Martinez, personal communication, May 30, 2013)

8. Lack of Legal Documents
 Many in their community do not have legal papers
 Have no job or have very low paying jobs
 "It is just not fair, how little our people are paid, they are
good and hard workers"
 They do not know were to go to get documents
 Many men have been deported
 Single mothers in the community
 "Problem is too that if they have accidents in jobs and
do not have papers, then they cannot get any money
or healthcare"
(M. Martinez, personal communication, May 30, 2013)

9. Domestic Violence
 Domestic violence is a problem in the Maya
community
 Both women and men are victims
 Alcohol is often involved
 "The Lake Worth police department sends them back
home to danger because they do not have anyone
who even speaks Spanish, so we try to tell our people
to come here and then we call the police to do the
report here because we can interpret”
 A young woman with her children was being helped as
we spoke. (M. Martinez, personal communication, May 30, 2013)

10. No Healthcare Coverage
 Due to lack of papers, they cannot qualify for Medicaid
and in day jobs do not have health insurance by their
employer
 Use Caridad Center in Boynton Beach
 Sometimes Health Department
 Traditional Healers
 Story of young man dropped off to the curb by hospital
(M. Martinez, personal communication, May 30, 2013)

11. Globalization
"Our people,
they are so worried about surviving themselves
here
every day"
(M. Martinez, personal communication, May 30, 2013)

12. Global Health Policies
”They have so many problems locally”
(M. Martinez, personal communication, May 30, 2013)

13. Community Leadership
"This center is the leadership with Father Frank,
who founded it. He is your people"
(M. Martinez, personal communication, May 30, 2013)

14. Community Leadership
 Two afterschool programs and this summer started a
new VPK program
 To help with children being home alone
 New counseling group meets Thursday nights. Hosted
by two nurses with a Honduran heritage who volunteer
their time
 Mothers of the runaway girls or victims of domestic
violence
 Partnerships with various organizations
 Legal help and help to get access to healthcare
(M. Martinez, personal communication, May 30, 2013)

16. Community Leadership
 Their action is through the use of various media
 TV (Channel 5)
 Radio (Radio Fiesta)
 Newspaper (Palm Beach Post)
 The locals will come to them if they hear about
anything concerning
 "It they hear something, they come to us".
(M. Martinez, personal communication, May 30, 2013)

18. Background
 Maya account for approximately sixty percent of the
population in Guatemala
 The largest indigenous groups in the Americas
 Ladinos have exploited them for centuries and still
continue in Guatemala today
 36 year war in Guatemala, started in 1960, resulted in
destruction of over 400 Mayan villages and the death
of over 200,000 people, majority of whom were
Mayans, causing many to flee to Mexico and to the
United States
(Burns, 1993; Brown and Odem, 2011; Green, 2009; Hiller, Linstroth, & Vela, 2009)

19. Background
 Many Guatemalan Mayan immigrants came to the
United States in the 1980s due to the immense
violence of the war
 Or in the late 1990s after the end of the Civil War in
1996, when the Mayan villages were terribly struck by
hunger, unemployment, and continued violence
 The Maya who came to Florida in the early 1980s
came as families, however, later in 1980s this
changed to mostly young men arriving alone
(Burns, 1993; Brown and Odem, 2011; Green, 2009; Hiller, Linstroth, & Vela, 2009)

20. Background
 The Guatemalan Mayan refugees come mostly from
rural, poor western highland villages where more than
twenty different Mayan languages are spoken
 Most of the Guatemalan Maya who arrived in Florida
came from the province of Huehuetenango and are
referred to as Kanjobal Maya here in the United States
 The indigenous heritage and injustice that
Guatemalan Maya experienced in their home country,
is often carried with them into their new life in the
United States
(Burns, 1993; Brown and Odem, 2011; Green, 2009; Hiller, Linstroth, & Vela, 2009)

21. Background
 1.1 million Guatemalans live in the United States
 81,887 Guatemalans in Florida
 19,615 in Palm Beach County
 4,358 in Lake Worth
 Lake Worth has the highest Guatemalan population of
all Florida cities
 Miami at second place with 4,060; West Palm Beach
at third place with 3,775
(Pew Research Center, 2013; U.S. Census Bureau, 201

22. Background
 Median age of Guatemalan in the United States is 27
 Median income is $17,000
 26 percent of them live in poverty
 Only 8 percent have at least a Bachelor's degree
(Pew Research Center, 2013)

23. Background
18
31
48
0
10
20
30
40
50
U.S. Hispanics Guatemalans
% of population without health insurance
(Pew Research Center, 2013)

24. Review of Literature
 Language and race
 Families and communities left behind
 Stress
 Health and illness
 Undocumented immigration

25. Review of Literature
Language and race
 The Maya are considered Native American and not
Latino or Hispanic
 Healthcare providers are often unaware of the
difference between Hispanic and Mayan
 Creates many problems in their care because their
traditions and language are vastly distinct.
 Mayans do not consider themselves Hispanic, nor
identify with the Latino community
(Czerwinski, LeBaron, & McGrew, 2011; Hiller et al., 2009)

26. Review of Literature
Language and race
 21 official Mayan languages in Guatemala and over 50 Mayan
dialects
 4 most common Mayan languages are Mam, K'iche, Chuj, and
Q'anjob'al
 The majority of the Lake Worth Mayan speaks Q'anjob'al today
 Some Mayan speak or understand Spanish or a non-standard
Spanish, called "la castilla"
 Critical need for interpreters of the various Mayan languages
because not speaking good enough Spanish or English is an
immense barrier to health care
(Czerwinski, LeBaron, & McGrew, 2011; Hiller et al., 2009)

27. Review of Literature
Families and communities left behind
 Today increasing amount of women are migrating
leaving their children to be cared for by other
caretakers, typically women, such as aunts and
grandmothers
 Remittance
 Discipline from abroad
 Separation
(Brown & Odem, 2011; Moran-Taylor, 2008)

28. Review of Literature
Stress
 Worrying about family’s safety back home
 Waiting in job pools on street corners in hope of having a
job for the day
 Feeling of not being acknowledged as skilled agricultural
workers
 Accept drinking over the weekend as a way to deal with the
multiple stressors
 Have a higher risk for stress and mental health disparities
because of their distinct culture, language, history of
trauma, and immigration status.
(Millender, 2010; Millender, 2012)

29. Review of Literature
Health and illness
 Illness is caused by an imbalance between hot and cold
elements in the body
 Use traditional healers and medicines, such as herbs, and
they often wait to seek help from Western medicine only if
these traditional methods are unachievable or their illness
has become serious
 The Mayan prefer to receive health information through
word-of-mouth communication
 Frightened by the healthcare system and mistrust the care
because their culture is disrespected
(Czerwinski et al., 2011; Long et al., 2012)

30. Review of Literature
Undocumented immigration
 Many Guatemalan Mayan work low paying jobs as day
laborers, as majority of them do not have documentation
due to the immigration laws that do not qualify them for
political asylum
 The United States immigration officials saw Guatemalan
Mayan as economic refugees and not political refugees
 1986 Immigration Reform and Control Act
 Obama administration’s immigration reform S.744
(Burns, 1993; Mayo, 2010; Ruiz, 2013)

31. Globalization
 At the grassroots, the Maya community in the Lake
Worth, does not have a sense of globalization
 Letter, on behalf of the Guatemalan-Maya
Center, Corn Maya, and IkBalam, to the Guatemalan
President, the high commissioner for human rights in
the United Nations and the office of high commission
of human rights in Guatemala
(M. Martinez, personal communication, May 30, 2013; The Guatemalan-Maya
Center, 2012 )

32. Globalization
Interconnectedness and interdependence between United
States and the Guatemalan Maya
 During the Civil War, the United States government sited
with the Guatemalan military and the U.S involvement has
been seen as the key aspect contributing to the human
rights violations during the war
 Causing Maya to flee to Mexico and to the United States
 The lack of U.S. authorities to recognize the Maya as
refugees
 Lack of legal papers is still a critical issue, which also affects
their access to healthcare and the quality of their care
(Bradbury-Jones, 2009; Miller, 2011)
“What happens in one country matters for the rest of the world"

33. Globalization
 Nurses are expected to be global citizens and be aware of
various issues that cross borders and impact all of us
 Influence of the United States globally, effects health care
and its determinants locally
 In 2009, President Obama started the Global Health
Initiative (GHI), and one of its focus areas is combating
malnutrition of the Maya women and children in the
highlands of Guatemala
 USAID also supports the indigenous women of Guatemala
and receives funds from the U. S. Global Health Budget
(Kriel, 2011; Mill, Astle, Ogilvie, &Gastaldo, 2010)

34. Leadership Strategies
1. Internationalizing the Curriculum
 According to the review of literature and the field
interview, the Mayan feel apprehensive about our
health care system and share that their culture is not
understood or respected
 Nursing education has the responsibility to prepare
students to give care in a global context
 Service-learning experience in a local, culturally
diverse community
 Study abroad experience in a Guatemalan Mayan
village

35. Leadership Strategies
Multidisciplinary Service-Learning
 The Maya Heritage Community Project (MHCP) is an
example of an interdisciplinary service-learning project
 Students and faculty from various disciplines, such as
history, education, and nursing, work together to serve the
local Mayan community
 Various service-learning projects, such as the toolkit for
health care providers, the handbook on teaching students
of Maya heritage, and helping with the Mayan annual
national conferences
(Kennesaw State University, 2011; National Service-Learning
Clearinghouse, 2013).

36. Leadership Strategies
Study Abroad
 Larson, Ott and Miles (2010) discuss the impact of
their school of nursing's first elective course offering a
two-week immersion experience in Guatemala
 Gained a deeper understanding of US politics in
developing countries, and recognized the intersection
of health and economics
 Allowed them to respect the traditions and beliefs of the
Mayan people, instead of seeing them as barriers to
health or as odd

37. Leadership Strategies
Study Abroad
 Wright (2009) explains that during the past six years
their school of nursing in the United States has offered
a study abroad clinical course in Botswana
 No matter where humans live, they have basic
similarities
 Partnered with a local school of nursing and after
several years, the faculty from the U.S. school of
nursing was asked to help the local school to start a
bachelor level program

38. Leadership Strategies
Internationalizing the Curriculum
 Interdependence in education involves moving away
from isolated institutions to collaborating with other
institutions and organizations both locally and
globally, with a goal of "harnessing global flows of
educational content, teaching resources, and
innovations"
(Frenk et al., 2010, p. 1924).

39. Leadership Strategies
2. Political Activism
 Nursing must be committed to social justice and social
responsibility should be its core value
 Health remains a goal to achieve and a commitment for
humanity
 One of the biggest issues that the field experience revealed
centered on the lack of legal documents
 Legal status would improve not only their wages and
chances for stable employment, but their access to and
quality of health care
 Political activism is a way to take action against racial
prejudice and social injustice, therefore promoting human
diversity and health care for all
(Kelley, Kun, Connor, & Salmon, 2008; Racine, 2009)

40. Leadership Strategies
2. Political Activism
 Healthcare is political because it is expensive and
there are limited resources to be matched with the
needs
 It is nurses' responsibility to get involved
 At this time of immigration reform, writing to Florida
Senator Rubio urging him to vote in favor of the
immigration reform bill, is a concrete and effective
leadership strategy that would help both provide the W
visas for the hard working Guatemalan Mayan
immigrants and allow for the unification of their
families
(Roux & Halstead, 2009)

41. Summary
 The field interview revealed that the challenges of the
Guatemalan Mayan people in Lake Worth are lack of
language, working too many hours, lack of legal
documents, domestic violence, and no healthcare
coverage
 The review of literature confirmed that especially
immigration and healthcare are of concern to the
Guatemalan Maya people in the United States.
 The review of literature further exposed that Guatemalan
Maya did not trust the healthcare in the United States, due
to their culture not being understood or even disrespected
 Through the stories told by M. Martinez, this same theme
for lack of cultural competence and distrust emerged

42. Summary
 The suggested leadership strategies were centered on the two
key needs of the community locally and globally:
1. Need for enhanced cultural competence for the nursing
profession
2. Migration as it relates to healthcare
 Including an interdisciplinary service-learning experience in a
local community and/or including a study abroad experience in
the nursing curriculum, were suggested as leadership
strategies for enhancing the cultural competence
 Political activism in a form of writing a letter to Florida Senator
was suggested as a leadership strategy related to migration
 Legalizing the Guatemalan Maya immigrants would not only
improve their social status from "second class citizens", but
would also assure them access to healthcare
(LeBaron, as cited in Hutto, 2013)

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